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PEFIMIT APPLICATION' <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425.257-8810 - FAX 425-257-8857 <br />'7�z�OS /7y O? oc:>q cep PUJ <br />SITE <br />]A%DDDR�ESS�% /� r PARCEL TAX I.D. # PERMIT a <br />LI /:_A /- f.�IL'-/I�f[✓ <br />LESC� LOT N0. BLOCK TRACT 9 _!�; )� zo 2 - —O 5- <br />OWNER l <br />OWNER ADDRESS ZIP PHONE <br />t8llos.�hs�e�er,s Rd#ZL�(] <br />L�cgc�j 4p jlP-) 1) 11tv OVA R825 $' <1Z5-�hcl- � <br />TENA T NAMk <br />✓CONTACT NAMI,.E, PHONE <br />,\ <br />CONTRACTOR L,OL+.Yl'IES1v W\y�C , ADDRESS ZIP CONTR. LICENSE k <br />l �tt�S. �►�S+e�elIny� �d: 2oci �`� LCG4e f 0q(1 eh <br />PHONE <br />PROPOSED USE OF BUILDING Building Mechanical Addition HEAT SOURCE <br />PERMITH Combination Plumbing WORK A:teralion Q'Electric <br />II TYPE Demolition Sign TYPE New Ly Gas <br />S r Sprinkler Repair/Maint u Other <br />CONTRACT PRICE OF WORK § CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION 4W <br />T PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />A/C - A/HANDLINGUNITS <br />BATHTUB 11 <br />1— <br />FORCED AIR SYSTEMS <br />�1 <br />LAVATORY (WASH BASIN) // // <br />HEAT PUMP <br />I <br />SHOWER I <br />— <br />UNIT HEATERS <br />i <br />KITCHEN SINK & DISPOSAL <br />CLOTHES DRYER <br />I <br />DISHWASHER <br />RANGE HOOD <br />— <br />LAUNDRY TRAY <br />_L <br />WATER HEATER <br />t <br />CLOTHES WASHER <br />— <br />METAL FIREPLACE/STOVE <br />— <br />URINAL <br />— <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />�_ <br />GAS FIREPLACE <br />FLOOR DRAIN <br />GAS RANGE <br />BACKFLOW PREVE^ITER <br />J <br />GAS PIPING <br />SINK (SERVICE/BAR/tviOP/ETC.) <br />�� <br />EXHAUST FAN <br />— <br />OTHER <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LA'A AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIE^ WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />9 // / ,2eo C/ <br />